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IJJ-E (FORM)- CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM

CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM

Type of Material:

? Book ? Magazine/Periodical ? Film ? Recording

? Software ? Other (please Specify:_______________________________________

Author (if known): ______________________________________________________________

Title: _________________________________________________________________________

Publisher (if known): ____________________________________________________________

Person making complaint: ________________________________________________________ \

Address: _________________________________ Telephone: __________________________

Complaint represents:

? Self

? Organization/Group (please name):

  1. Why do you object to this material?

  2. Identify any particular sections to which you object. (Please be specific: cite pages, scenes, etc.)

  3. What are the positive aspects of this material?

  4. Did you read/view/hear all of the material? If not, what parts did you read//view/hear?

  5. Please identify any professional review/judgments of this material that you have read.

  6. What would you like the school to do about this material?

? Do not assign to any students. ? Withdraw it from the library and/or instructional program.

Signature of Complainant | Date

Cross Reference:

Adopted:

  • September 10, 2013
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